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Binge Eating Disorder

By
Evelyn Attia, MD, New York Presbyterian Hospital, Weill Cornell Medical College;New York State Psychiatric Institute, Columbia University Medical Center;B. Timothy Walsh, MD, College of Physicians and Surgeons, Columbia University;New York State Psychiatric Institute

Binge eating disorder is characterized by the consumption of large amounts of food with a feeling of loss of control (bingeing). Binge eating is not followed by attempts to compensate for the excess food eaten—for example, by ridding the body of the excess food consumed (purging).

Binge eating disorder is more common among people who are overweight or obese.

People eat large amounts rapidly, do not purge, and are very distressed by their behavior.

Doctors base the diagnosis on people’s description of their behavior.

Weight-loss programs and some weight-loss drugs may help control weight, cognitive-behavioral therapy may help control the binges, and a selective serotonin reuptake inhibitor (a type of antidepressant) may do both.

Overall, about 3.5% of women and 2% of men have binge eating disorder. But the disorder becomes more common with increasing body weight. In some weight reduction programs, 30% or more of obese people have the disorder.

Most people with binge eating disorder are overweight or obese, and the disorder contributes to their consumption of excessive calories. In contrast, most people with bulimia nervosa have a normal weight, and most people with anorexia nervosa are thin. People with binge eating disorder are older than those with anorexia nervosa or bulimia nervosa, and nearly half are men.

Did You Know?

Nearly half of the people with binge eating disorder are men.

Symptoms

During a binge, people eat a much larger amount of food than most people would eat in a similar time under similar circumstances. During and after a binge, people feel as if they lost control. Binge eating is not followed by purging (by inducing vomiting or misusing laxatives, diuretics, or enemas), excessive exercising, or fasting. Binge eating occurs in episodes, as opposed to constant overeating. Affected people may also do the following:

Eat much more rapidly than normal

Eat until they feel uncomfortably full

Eat large amounts of food when they do not feel hungry

Eat alone because they are embarrassed

Feel disgusted, depressed, or guilty after overeating

People with binge eating disorder are distressed by it, especially if they are trying to lose weight. People are more likely to have depression or anxiety compared with those who do not have the disorder.

Diagnosis

A doctor's evaluation

Doctors diagnose binge eating disorder when

People report binge eating once a week for at least 3 months.

Binges are accompanied by a feeling of no control over eating.

People have typical symptoms and behavior.

Treatment

Psychologic therapy

Certain antidepressants

Possibly weight-loss drugs and appetite suppressants

Most people are treated in conventional behavioral weight reduction programs. Although these programs pay little attention to binge eating specifically, people tend to accept this because they are usually more concerned about their weight than about their binge eating. Conventional weight reduction programs are effective in not only producing weight loss but also in helping control binge eating. Binge eating apparently does not limit weight loss in these programs.

The following treatments may help:

Cognitive-behavioral therapy can help control binge eating over the long-term but has little effect on body weight.

Interpersonal psychotherapy is as effective as cognitive-behavioral therapy but also has little effect on body weight.

Selective serotonin reuptake inhibitors (a type of antidepressant), such as fluoxetine, can control binge eating and weight.

Weight-loss drugs (such as orlistat) or appetite suppressants (such as topiramate) may help with weight loss.

Self-help groups that follow the principles of Alcoholics Anonymous (such as Overeaters Anonymous and Food Addicts Anonymous) are widespread, but their effectiveness is uncertain.

Surgery may be done to treat obesity, but its effects on binge eating are unclear.

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